RESUMO
BACKGROUND: Persistent swallowing disorders (SD) are non-pulmonary complications of mechanical ventilation (MV). However, there are few clinical studies on persistent SD in critically ill patients undergoing tracheal intubation for MV. The aim of the present study was to assess the incidence and characteristics of clinical manifestations associated with persistent SD. METHODS: We prospectively evaluated in patients requiring more than 7 days of invasive MV the incidence and characteristics of clinical manifestations related to persistent SD. For this purpose, quality of swallowing was assessed within 24 h after extubation by an experienced physical therapist not directly involved in patient management. Swallowing assessment consisted in a specific standardized test combining a swallowing test and a full clinical evaluation of the cranial nerves involved in swallowing. In patients with SD on the first test, a second test was done within 48 h in order to discriminate between transient and persistent SD. RESULTS: Among the 482 patients mechanically ventilated more than 7 days, 138 were enrolled in this study. The first test performed 24 h after extubation revealed SD in 35 patients (25%). According to the second test performed 48 h later, SD were considered transient in 21 (15%) and persistent in 14 (10%) cases. Patients with persistent SD were older (66 ± 16 vs 58 ± 15 years), had lower bodyweight at admission (76 ± 15 vs 87 ± 23 kg) and received less often neuromuscular blocking agents (36% vs 66%) compared to patients without or with only transient SD. Patients with persistent SD had longer duration of Intensive Care Unit (ICU) stay after first extubation and longer delay to oral feeding than patients without or with only transient SD, respectively, 11 ± 9 vs 7 ± 6 days and 23 ± 33 vs 5 ± 7 days. CONCLUSIONS: Based on a specific standardized clinical test, 25% of patients mechanically ventilated more than 7 days exhibited clinical manifestations of SD. However, SD were considered as persistent after extubation in only 10% of them. Persistent SD were associated with longer duration of ICU stay after extubation and longer time of enteral feeding. TRIAL REGISTRATION: The study is registered with Clinical Trials (NCT01360580).
RESUMO
This work reports the determination of ultra-trace of Sb(III) in seawater by using a stripping chronopotentiometric (SCP) method with a mercury film electrode. A sensitivity and detection limit of 360 ms L microg(-1) and 8 ng L(-1) (70 pM), respectively, were accomplished for a 15-min electrolysis time. Compared to the only two chronopotentiometric methods reported for Sb(III) determination in seawater, our method is more sensitive and does not need to use a medium exchange procedure before the stripping step. Moreover, the use of a double electrolysis potential (-450 mV and -250 mV) allows the analysis of Sb(III) independently from the Cu level in the sample. The method was successfully used to study the behaviour of dissolved Sb(III) in the Penzé estuary, NW France.
